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Introduction: The prevalence of visual impairment and ocular diseases changes over time. This measure can help general practitioners in anticipating common eye disorders that may require ophthalmological referrals to government hospitals. This study aimed to evaluate the prevalence of visual impairment and ocular diseases in an outpatient ophthalmology clinic in a public hospital and the types of investigations frequently conducted to diagnose these diseases., Methods: A cross-sectional prospective study was conducted over three weeks in the eye clinic of the University of Malaya Medical Centre. The electronic medical records of all patients who attended the outpatient clinic were assessed to collect data on sex, age, type of visit, visual acuity, ocular presentation, investigations conducted and diagnosis of eye diseases. Visual impairment and blindness were categorised as per the World Health Organization criteria., Results: Among 1002 patients, 327 had visual impairments (32.63%), and nine had blindness (0.9%). Cataracts were the most common ocular disease diagnosed (n=294, 29.74%), followed by glaucoma (n=123, 12.28%) and diabetic retinopathy (n=84, 8.38%). Optical coherence tomography was the most common investigation performed (n=272, 64.9%), followed by Humphrey visual field testing (n=53,12.6%)., Conclusion: Untreated refractive error is the leading cause of visual impairment in children, while cataract, glaucoma and diabetic retinopathy are the main contributors to visual impairment and blindness in elderly individuals. Our study highlights the urgent need for general practitioners to recognise avoidable visual impairment in all age groups to help prevent blindness., Competing Interests: The authors declare that they have no conflicts of interest., (© Academy of Family Physicians of Malaysia.)

Aim: To determine the common causes and visual outcome after treatment among uveitis and scleritis patients., Methods: This is a retrospective cohort observational study. All consecutive clinical records of patients with newly diagnosed uveitis and scleritis over a 4-year period, from Jan. 1, 2017 to Dec. 31, 2020, were analysed. Data was collected at the presentation and included a follow-up period of one year., Results: A total of 288 patients were recruited during the study period. Anterior uveitis was the most common anatomical diagnosis (50.0%) followed by panuveitis (25.0%), scleritis (13.5%), posterior uveitis (6.9%), and intermediate uveitis (4.5%). Viral Herpes was the most common cause of infectious cases, while Vogt-Koyanagi-Harada (VKH) disease and human leucocyte antigen (HLA) B27 spondyloarthropathy were the leading causes of identifiable non-infectious cases. Majority of patients presented with unilateral, non-granulomatous uveitis with an absence of hypopyon. Anatomical locations like posterior uveitis and panuveitis, and visual acuity worse than 3/60 at presentation were the factors associated with poor visual outcomes ( P <0.05). About 60% of patients had an identifiable cause for the uveitis and scleritis, with nearly equal distribution of infectious ( n =85, 29.5%) and non-infectious causes ( n =84, 29.2%). About 14.5% of patients were clinically blind at 1y of follow-up. The most common complication in our uveitis patients was glaucoma (47.5%), followed by cystoid macula oedema (18.9%) and cataract (13.9%)., Conclusion: Uveitis and scleritis are important causes of ocular morbidity. They are potentially blinding diseases which can have a good outcome if diagnosed and treated early., Competing Interests: Conflicts of Interest: Seow ST, None; Tajunisah I, None; Lee FY, None; Lott PW, None; Reddy SC, None., (International Journal of Ophthalmology Press.)

Aim: Tono-pen measurement of intraocular pressure (IOP) under topical anaesthesia in full term normal newborns., Methods: The IOP measurements were taken using Tono-pen XL tonometer under topical anaesthesia in 150 newborns (300 eyes) within 24h after birth, over a period of three months, in a university hospital. Gender, gestation period, mode of delivery and birth weight of newborns were noted from medical records., Results: There were 70 males and 80 females. All babies were Malays. The IOP measurements were taken between 12 and 24h after birth. The gestation period of babies ranged between 37 and 41 weeks; 118 babies were delivered by spontaneous vaginal delivery and 32 by caesarian section. The birth weight of babies ranged between 2.1 and 4.3kg. The mean IOP of 300 eyes was 15.99±2.79mmHg (range 8-22). There was no statistically significant difference of mean IOP and gender, laterality of eye, type of delivery, gestation age, or birth weight of newborns., Conclusion: The IOP in full term normal newborns was 16mmHg. Tono-Pen appears to be ideal instrument for taking IOP in newborns because of its small size and easy handling.

Aim: To evaluate the frequency of bacterial flora of conjunctiva after death (cadaver eyes) which will give information about the bacterial contamination of donor eyes, and the in-vitro sensitivity of isolated bacteria to the commonly used antibiotics in ophthalmic practice., Methods: Conjunctival swabs were taken from the cadavers (motor vehicle accident deaths and patients who died in the hospital), within 6h after death, and sent for culture and sensitivity test. Conjunctival swabs, taken from the healthy conjunctiva of patients admitted for cataract surgery, were sent for culture and sensitivity as controls (eyes in those of living status). The bacterial isolates were tested against the commonly used antibiotics (chloramphenicol, gentamicin, ciprofloxacin) in ophthalmology practice., Results: Bacteria were isolated in 41 out of 100 conjunctival swabs (41%), taken from 50 cadavers (study group). Coagulase negative staphylococcus was the most common bacteria isolated (15%), followed by pseudomonas aeruginosa (5%). Gentamicin was effective against majority of the bacterial isolates (82%). Bacteria were isolated from 7 out of 100 conjunctival swabs taken as control group (eyes in living state). Coagulase negative staphylococcus was the most common organism (5%) isolated in control group; the others were staphylococcus aureus (1%) and beta hemolyticus streptococci (1%)., Conclusion: Bacteria were isolated from 41% of the cadaver eyes. High percentage sensitivity of the bacterial isolates to gentamicin (82%) supports the practice of thorough irrigation of the eyes with gentamicin solution before starting the procedure of enucleation followed by immersion of the enucleated eyeballs in gentamycin solution, to prevent the bacterial contamination.

Aim: To report various ocular lesions caused by accidental instillation of superglue., Methods: Three cases of ocular injuries are described in children aged 6 years, 3 years and 8 months, following accidental instillation of superglue in the eye., Results: In the first case there was sticking of eyelashes in the medial 1/3 of eyelids in both eyes. In the second case sticking of eye lashes was present in the lateral 1/3 of eyelids in the left eye. In the third case, superglue was present on the right cheek, above the right ear and sticking of eyelids in medial 1/3 in right eye. The eyelids were separated by pulling the lid margins with fingers in the first case and later on superglue was removed by trimming the eyelashes; and by direct trimming the eyelashes in second and third cases. There was no injury to other structures of anterior segment in the first two cases. However, removal of the superglue on the cornea resulted in corneal abrasion in the third case which healed with medical treatment and patching of the right eye., Conclusion: Accidental instillation of superglue is possible because of the appearance of the tube like eye ointment tube. Immediate medical aid will prevent ocular morbidity.

Aim: To report various ocular injuries caused by durian fruit., Methods: Three cases of ocular injuries were described in young patients, due to accidental fall of durian fruit on the forehead and face, while they were taking rest/sleeping /playing under the durian tree., Results: The ocular injuries observed were lacerating injury of cornea with iris incarceration, hyphema, superficial penetrating injury of sclera and angle recession glaucoma in the right eye of first patient; lacerating injury of cornea with iris prolapse in the left eye of second patient; subconjunctival haemorrhage, traumatic mydriasis and superficial penetrating injury of sclera, commotion retinopathy and macular edema in the left eye of third patient. Vision improved to normal in all the eyes following surgical/ medical/optical treatment., Conclusion: Evidence of penetrating injury (because of thorns) and blunt injury (because of weight) can be seen in the eyes when durian fruit falls on the face. Vision can be recovered fully with immediate and appropriate treatment in these cases. The ocular injuries can be prevented by educating the public to wear protective metal frame wide goggles and not to sleep/take rest under the durian tree.

Aim: To determine the asymmetry in the sympathetic activity in the eyes as indicated by intraocular pressure (IOP)., Methods: In a prospective cross sectional study, the IOP in 150 newborns, 80 young adults and 159 old people was measured with Tono-Pen under topical anaesthesia., Results: The mean IOP in the newborns was 16.16mmHg in right eye and 15.79mmHg in left eye; in young adults 15.04mmHg in right eye and 14.71 in left eye; in old people 15.16 in right eye and 15.03 in left eye. A statistically significant higher IOP was noted in the right eye in the newborns (P=0.03) and in young adults (P=0.02), but not in the old people (P=0.26). The higher IOP in the right eye indicates the lowered sympathetic activity in that eye., Conclusion: We hypothesize that the sympathetic asymmetry in the bilaterally placed organs helps to establish the dominant pattern of the organ in the body.

Purpose: To compare the measurements of the optic cup diameter with B-scan sonography with fundus photography in patients with clear ocular media and to propose a solution for the clinical problem of determining the cup-disc ratio in eyes with opaque ocular media., Methods: We studied 122 patients (glaucoma patients and non-glaucoma controls) with clear ocular media. Measurements of optic cup diameters using Quantel 10 MHz B-scan sonography were compared with magnification-corrected measurements of the same area using Zeiss FF450 Plus fundus camera. Paired-sample t-test was used to compare the measurements. The correlation between measurements of optic cup diameters using the 2 methods was established. In addition, the optic disc diameters of both eyes were measured on fundus photographs and compared with each other., Results: There was no significant difference between the fundus photographic and sonographic measurements of optic cup diameters. There was no difference in the fundus photographic measurements of optic disc diameters between the 2 eyes., Conclusion: In an eye with opaque ocular media, the cup-disc ratio can be calculated by using the optic cup diameter of this eye with B-scan sonography and the optic disc diameter of the fellow eye with clear media measured by fundus photography.

Purpose: To report an unusual case of bilateral simultaneous hypopyon corneal ulcer in a contact lens wearer caused by polymicrobial infection with rare organisms., Methods: A case report of a 21-year-old soft contact lens wearer, who visited the emergency department with a 3-day history of pain, redness, decreased vision, photophobia, and tearing in both eyes. Examination showed a central corneal ulcer with hypopyon in both eyes. The cultures from corneal scrapings of both eyes, the contact lenses, and the contact lens solution showed heavy growth of Pseudomonas aeruginosa, Alkaligenes species, and Flavobacterium meningosepticum., Results: The corneal ulcers healed completely with aggressive antibiotic treatment for 4 weeks. The best-corrected visual acuity after 6 months of follow-up was 20/400 in the right eye and 20/60 in the left eye., Conclusions: The possibility of infectious keratitis should be kept in mind for an acute red eye in contact lens wearers, and appropriate initial management is essential for a successful outcome. It is believed that this is the first report of Flavobacterium meningosepticum as a causative organism in contact lens-related keratitis.

We report a case of unilateral acute retinal necrosis (ARN) with marked vitritis and retinal necrosis leading to retinal breaks following chicken pox successfully treated with intravenous acyclovir followed by oral acyclovir, orbital floor triamcinolone injections to contain the inflammation, and barrier laser therapy to secure the retinal breaks with good visual outcome. This case is unusual in its severity and the novel use orbital floor triamcinolone therapy to contain ARN inflammation.

A survey of colour vision deficiency among 1427 medical students and healthcare personnel in Seremban revealed a prevalence of 3.2% with a marked male predominance (males 6.7%, females 0.4%). In view of the potential difficulties faced by such personnel in clinical works, early detection of this deficiency allowed appropriate counselling.